Injectible Fillers

You can't see them, but the tissues under your facial skin are working hard for you, continuously, whether you're awake or asleep. Together with your facial muscles and nerves, they're involved every time you smile, talk, eat, squint or laugh. But over the years, like other parts of your body, they're adversely affected by the pull of gravity, by exposure to the sun, natural aging, and by other factors.

These underlying tissues-these marvelous tissues that keep your skin looking young and alive and plumped up (in a nice way)-start to break down as you grow older. Laugh lines and smile lines become permanent, rather than temporary. Crow's feet and facial creases start to set up permanent residence in the areas of your skin where facial muscles do their work. Your cheeks start to sink in. And almost before you realize it, you're looking older.

But help is available. Through the use of soft-base fillers-such as injectable collagen or fat-your cosmetic surgeon can fill in these unsightly lines, creases, and "sinkholes" to help you look younger, with a smoother skin. When injected by an expert, these fillers can add fullness to the lips and cheeks, and reduce or erase those unsightly lines and creases. They can be used alone, together with a facelift, or in conjunction with a laser treatment that resurfaces the skin.

Q. What options are offered?

A. If you'd like to improve the texture and general appearance of your facial skin, or fill out sunken cheeks, deep wrinkles, furrows and creases, consider injected collagen or fat. They can also add more fullness to the lips, and help make some types of scars less visible.

Collagen, a protein derived from purified cow skin, is sold under the trade names Zyderm® and Zyplast® and is produced by the Collagen Corp. in various thicknesses. Primarily, it's used to fill in wrinkles, lines and scars on the face or, less often, those on the neck, back and chest.

The fat-injection procedure is also known as autologous fat transplantation, or as microlipoinjection. Fat cells are extracted from the patient's own body-often from the abdomen, thighs or buttocks-and injected into the facial skin. It's commonly used to fill in sunken cheeks and laugh lines, correct skin depressions, minimize wrinkles, and enhance the lips.

Besides collagen and fat, other commonly used injectables include:

• Fibril®-a gelatin powder compound mixed with a tiny amount of the patient's blood and injected to plump up the skin.
• Gortex®-a thread-like material, implanted under the skin to help support soft tissues.
• Restylane®, Hylaform® and Captique®-fillers similar to a collagen, but lasting longer (up to nine months), depending on the injection site. They're made from "hyaluronic acid," a normal component of all living organisms.
• RadiesseT-formerly called Radiance-made from the same calcium compound found in bone. It can last up to two years or, with a touch-up, even five years
• Botox®-the brand name of a cosmetic form of botulinum toxin. It temporarily reduces or eliminates forehead creases, frown lines, and crow's feet by blocking the nerve impulses and temporarily paralyzing the facial muscles that cause wrinkles. It can give the skin a smoother and more relaxed appearance.

Injectables can create dramatic, eye-pleasing changes. But the results are only temporary, lasting a few weeks or months (the injected substance is metabolized by the body, at various speeds), unless the injections are repeated. How long each injection remains effective depends, in large part, on the patient's age, genetic makeup, skin quality and lifestyle, the quantity injected, and the size of the area affected. Some patients' bodies are more receptive to certain injectables than others.

Q. What are the risks?

A. Complications are infrequent and usually minor when a qualified plastic surgeon is handling the procedure. With collagen, an allergic reaction is possible for some patients. That's why an allergy skin test should be performed a month or so before the procedure appointment. If, during the next three or four weeks, there are signs of redness, swelling or itching at the test site, this should be reported to the surgeon and collagen may be ruled out. When fat is chosen as the injectable, there is hardly ever an allergic reaction because the fat is from the patient's own body. Other potential risks include infection and failure to heal (a possibility with heavy smokers).

Q. Where is the procedure performed?

A. Usually in the surgeon's own medical facility. However, if you are having a cosmetic surgery procedure, your injections may be given at the same time.

After the injection site-and extraction site, when fat cells are used-is cleaned, a local anesthesia is used. (None is needed with collagen, because it comes already mixed with lidocaine, an anesthetic, but a numbing spray can be applied upon request.) The material is injected, using a needle. Depending on the injectable used, overfilling may be necessary, resulting in a swollen appearance, which is temporary. If you also received anesthesia or a sedative, have someone drive you home.

If a large area was treated, you may want to cut back on your activities for a time. Expect some swelling, bruising and redness, which may last for a brief time or for up to several weeks in some cases. (Ask your doctor what to expect.) For about 48 hours after the injection, avoid the sun, while the redness and bruising fade away.

As many celebrities and "common folk" can attest, you should be very satisfied with how your face looks as a result of this cosmetic treatment. But, as they say, "Don't try this at home!"